Update: Three New State Mandated Changes

In August 2012, Governor Deval Patrick signed three Massachusetts health care-related bills into law. As a result, we have updated our plans to reflect the following changes.

Hearing Aids for Children

We provide coverage for children (age 21 or younger) for the cost of one hearing aid per hearing impaired ear, up to $2,000 every 36 months. This coverage also includes services related to a covered hearing aid device prescribed by a licensed audiologist, hearing instrument specialist, or an ear, nose, and throat (ENT) doctor, including:

The initial hearing aid evaluation

Fitting and adjustments

Qualifying supplies such as ear molds

The member may choose a higher-priced hearing aid, but will need to pay the difference in cost above the $2,000 coverage limit. Coverage is subject to all of the requirements of the health plan and doesn’t include replacement hearing aid batteries.

For insured accounts and administrative service contract (ASC) municipal accounts, this change is effective beginning with January 1, 2013 renewal dates1. For all other renewing ASC accounts, this coverage change will not be applied unless the account requests it.

Cleft Lip and Cleft Palate Treatment for Children

We provide coverage for treatment of a cleft lip and cleft palate for children under the age of 18. This coverage includes benefits for:

Medical, dental, oral, and facial surgery

Surgical management and follow-up care by oral and plastic surgeons

Orthodontic treatment and management

Preventive and restorative dentistry

Speech therapy

Audiology and nutrition services

We have updated our health plans to include the necessary dental and orthodontic services to treat these conditions. Please refer to the evidence of coverage for details. Coverage is subject to all of the requirements of the health plan.

For insured accounts and ASC municipal accounts, the change is effective beginning with January 1, 2013 renewal dates1. For all other renewing ASC accounts, the coverage change to add dental and orthodontic benefits will not be applied unless the account requests these benefits.

Physician Assistants Consumer Choice

Under the new law, physician assistants in Massachusetts will have the opportunity to become participating providers. We will cover care provided by participating physician assistants for health maintenance, diagnosis, and treatment and will include them on our list of participating providers. Members will be able to select physician assistants as primary care providers.

We updated our members' subscriber certificates on January 1, 2013 (for a one-day change for all subscriber certificates). Because this expansion of provider type requires a different billing arrangement, this change applies to all insured and ASC accounts.